Six-month Evaluation Research Articles

Potential of Acacia Extract as a Collagen Crosslinker and Stabilizer of the Resin-dentin Interface.

The aim of this study was to investigate whether different concentrations of acacia extract could improve the biological stability of dentin collagen. Slice (n=3) and beam (n=5) samples of dentin obtained from human third molars were demineralized and treated with the following solutions: G1 (control)-deionized water; G2-1% acacia extract; G3-2% acacia extract; and G4-3% acacia extract. The dentin slices were analyzed by Fourier transform infrared (FTIR) spectrophotometry to observe their interactions with collagen. The beams were submitted to digestion with type I bacterial collagenase solution, and the percentage of weight was calculated to evaluate the resistance to enzymatic biodegradation. The Adper Scotchbond Multipurpose adhesive system was applied on the flat dentin surfaces according to the manufacturer's recommendations (G1). In groups G2, G3 and G4, acacia extract at concentrations of 1%, 2%, and 3%, respectively, were applied after acid etching. A resin composite block was built on the adhesive, and the teeth were cut to obtain beams (n=7 teeth; ~12 beams per tooth) with cross-sectional areas of approximately 0.8 mm2. Half of the specimens were submitted to the microtensile bond strength (µTBS) test in a universal testing machine at a crosshead speed of 0.5 mm/min, and the other half were submitted to the µTBS test after six months of storage in distilled water. FTIR analysis showed the interactions of the three concentrations of acacia extract with collagen. According to ANOVA and Tukey tests, G1 had the highest biodegradation rate (100%), which was significantly higher than the rates of G2 (24%), G3 (23%) and G4 (17%) (p<0.05). According to two-way ANOVA and Tukey tests, only G1 showed a significant decrease in µTBS after six months of storage (p<0.05). It was concluded that 1%, 2%, and 3% acacia extract all interacted with human dentin collagen, reduced collagen biodegradation and favored the stabilization of the bonding interface at the six-month evaluation.

Potencial Simbiótico de Microrganismos do Solo na Promoção do Crescimento de Espécies Arbóreas da Mata Atlântica

The objective of this study was to evaluate the potential of topsoil obtained from a natural forest fragment in the Brazilian Atlantic Forest to serve as a source of symbiotic microorganisms capable of promoting the growth of native tree species in ecological restoration projects. In greenhouse conditions, 14 experiments in a completely randomized design were conducted in 1,700 cm³ pots filled with sterilized substrate. The effect of adding 80 g of topsoil, either in natura or sterilized, to the substrate was tested on the growth of 14 tree species. Plant height, stem diameter, mycorrhizal colonization and dry masses of shoot, roots, and nodules of tree species were measured. Applying the topsoil to the pots generally resulted in significant increases in height and stem diameter of seedlings compared to the control group during the four to six-month evaluation period. This effect was particularly greater in the nodulating species Plathymenia reticulata, Dalbergia nigra and Mimosa bimucronata, with increases in height and stem diameter of up to 328% and 484%, respectively. Forest topsoil also had a positive impact on the growth of shoot, roots, and nodules of the plants, significantly differing from the control groups. Only the plants that received the topsoil in natura exhibited mycorrhizal colonization and the formation of nodules in nitrogen-fixing species. These plants that established mycorrhizas and nodules presented higher concentrations of phosphorous and nitrogen in their biomass, respectively. Under controlled conditions, the use of forest topsoil proved to be a promising strategy for the introduction of microorganisms that can enhance the growth of tree species, thereby holding potential for implementation in nurseries and field settings.&#x0D; &#x0D;

Entire papilla preservation technique for treatment of periodontal intrabony defects: a series of cases.

Periodontitis is characterized by bone resorption. Vertical bone loss results in an intraosseous defect. Multiple surgical approaches for treating intrabony defects have shown different grades of effectiveness. Recently, the entire papilla preservation technique has been proposed, improving clinical parameters, such as pocket depth and clinical attachment level. This series of cases aimed to describe the use of the entire papilla preservation surgical technique without using biomaterials to regenerate periodontal intrabony defects. The influence on the clinical periodontal parameters and radiographic parameters was measured through CBCT, the latter not described until now, and analyzed the possible postoperative complications. A total of six intrabony periodontal defects associated with at least one periodontal pocket with probing depths equal to or greater than 6 mm were treated with the entire papilla preservation technique. The clinical and radiographic parameters were evaluated at the beginning and 6 months after surgery. The mean probing pocket depth reduction was 4.00 ± 0.63 mm, the mean clinical attachment level gain was 3.67 ± 1.03 mm, and the mean radiographic intrabony filling was 2.41 ± 2.03 mm. Early healing was uneventful; the mean visual analog scale at 7 days was 0. This minimally invasive technique results in an improvement in clinical and radiographic parameters, the latter showing a filling of the bone defect observed during the 6-month evaluation after surgical treatment. These results confirm the importance of clot and flap stability in regenerating intraosseous defects.

Comparison of the Efficacy Between Standard Measurement-Base Care (MBC) and Enhanced MBC for Major Depressive Disorder: A Pilot Study.

To validate the efficacy of enhanced measurement-based care against standard measurement-based care in patients with major depressive disorder. In this pilot study of an ongoing multicenter cluster randomized controlled trails, 160 patients diagnosed with major depressive disorder were enrolled from 2 mental health centers, with a plan to include 12 centers in total. One hundred patients engaged in a six-month evaluation using a technology-enhanced measurement-based care tool, including assessments of clinical symptoms, side effects, and functionality at baseline, two months, four months and six months. Simultaneously, the remaining 60 patients underwent standard paper-based measurement-based care, utilizing the same set of scales over the same six-month period, with assessments at the same time points. Patients utilizing the enhanced measurement-based care tool demonstrated a significantly higher reduction rate in PHQ-9 scores compared to those using standard paper-based measurement-based care during the two-month follow-up. Additionally, a notable positive correlation was observed between the frequency of enhanced measurement-based care tool usage and the quality of life during the two-month follow-up. Enhanced measurement-based care has the effect of reducing depressive symptoms. Our study emphasized that using enhanced measurement-based care via smartphones is a feasible tool for patients with major depressive disorder. Our future study, including results from additional research centers, may further validate the effectiveness of enhanced measurement-based care.

Are Overweight and Obesity Risk Factors for Developing Metabolic Syndrome or Hypertension after a Preeclamptic Event?

To identify the determinants and risks associated with developing hypertension and metabolic syndrome in the first year postpartum in women who experienced preeclampsia. A cohort study was conducted, involving women who had experienced preeclampsia (PE) recently. The control group was women with the same characteristics but a healthy pregnancy. The variables analyzed were somatometry, disease history, pre-pregnancy body mass index (Pre-BMI), and Third Adult Treatment Panel updated (ATP III) metabolic syndrome (MS) data (blood pressure, obesity, triglycerides, high-density lipoproteins, and fasting glucose). These variables were measured at 3, 6, and 12 months postpartum. Women with a history of PE exhibited higher systolic and diastolic blood pressure than women without PE. The risk of developing isolated diastolic arterial hypertension at 3 and 12 months of follow-up was two to eight times greater in women with a history of PE. Factors associated with having higher blood pressure levels were preeclampsia, insulin resistance, age, and BMI. Neither the pre-BMI index nor gestational weight gain (GWG) had any effect on blood pressure in any of the three assessments. Women with preeclampsia had a 5- to 8-fold increased risk of developing MS (which could be explained not only by the history of preeclampsia but also by the history of pre-pregnancy obesity). However, PE was not identified as a risk factor at the six-month evaluation and was only explained by pre-pregnancy obesity and overweight. Obesity and overweight, as well as preeclampsia, were strongly associated with the development of hypertension and metabolic syndrome during the first year following childbirth.

Application of Single Index Model to Determine Optimal Stock Portfolio (A Case Study on IDX30 in 2022)

Stock represent proof of ownership or participation of an individual or entity in a company. Investors gain profits from shares through capital gains and dividends. The difficulty in selecting an optimal composition of a stock portfolio is a major concern for investors. This study aims to determine the optimal composition of a stock portfolio, calculate the expected returns in the future, and assess the potential risks that investors may encounter later on. The data for this research consists of stocks listed on the IDX30 Index throughout the year 2022, which consistently appear in every six-month evaluation. The analysis is conducted using a single-index model. Based on the findings of this study, the following ten stocks are identified as the optimal portfolio constituents: KLBF with a weight of 17.20%, BBRI with a weight of 17.18%, BBCA with a weight of 17.08%, PTBA with a weight of 12.46%, BBNI with a weight of 9.89%, UNVR with a weight of 8.33%, INKP with a weight of 8.66%, ICBP with a weight of 5.56%, BMRI with a weight of 3.25%, and UNTR with a weight of 0,39%. The expected return from the formed portfolio is 0,1% per day, with a corresponding risk of 0,004%.

Enhanced sucrose-mediated cryoprotection of siRNA-loaded poly (lactic-co-glycolic acid) nanoparticles

The present study aimed to determine the effects of sucrose on the physical stability, cellular entry pathways and functional efficacy of poly(lactic-co-glycolic acid) nanoparticles (PLGA-NPs). PLGA-NPs were synthesized in the absence or presence of 10 % sucrose, using HEI-101, an unmodified small interfering RNA (siRNA), as a drug model. The newly synthesized HEI-101-loaded PLGA-NPs (HEI-101-NPs) were exposed to repeated freeze-thaw cycles and iteratively tested over a six-month evaluation period. The effect of sucrose stabilization on HEI-101-NPs was independently tested in vitro for biocompatibility and cellular uptake in IMO-2B1 cells. Data analyses suggest that, without sucrose, freeze-thaw cycles of HEI-101-NPs resulted in increased particle diameter, increased polydispersity index, and reduced zeta potential. In contrast, a substantial improvement in the physical stability of HEI-101-NPs was observed in the presence of 10 % sucrose. The data revealed that the release of HEI-101 from the PLGA-NPs was governed by polymer erosion and drug diffusion. Data from cellular uptake study in IMO-2B1 cells demonstrated that, 10 % sucrose significantly reduced the inhibitory effect of nocodazole on the microtubule-dependent uptake of PLGA-NPs. In addition, the presence of 10 % sucrose seemed to lessen the inhibitory effect of sodium azide on the energy-dependent uptake of PLGA-NPs. Overall, the current data suggest that the cellular internalization of PLGA-NPs occurred through the polymerization of actin filaments under the control of the microtubules. Our findings reveal cryoprotective effect of 10 % sucrose on HEI-101-NPs that confers marked improvements in the stability, cellular uptake and efficiency for the delivery of biomolecules to inner ear cells.

Osteointegration analysis with serial radiography as a predictor of successful cementless bipolar hemiarthroplasty at surabaya orthopaedic and traumatology hospital

Osteointegration is a direct structural relationship between the bone and the implant surface, a properly osseointegration implant can function without mobility. We aim to evaluate this process using serial radiological examinations, where characteristics such as bone sclerosis and cortical-periosteal thickening will be investigated. A retrospective analytic-observational study was conducted on 96 patients after cementless bipolar hemiarthroplasty operation from January 2012 to January 2021, examined for standing pelvic or hip anterior-posterior radiographs after six weeks, six months, and a year post-procedure at Surabaya Orthopaedic and Traumatology Hospital. Two musculoskeletal radiology consultants blindly evaluated for bone sclerosis, femoral stem positioning or stem angulation, cortical-periosteal thickening, and leg length discrepancy. The study was conducted on 24 male subjects (25%) and 72 female subjects (75%). Bone sclerosis significantly appeared in the six-month evaluation. There was no difference in femoral stem positioning. Cortical-periosteal thickening was found on the medial side according to the valgus position of the stem and began to appear in the 6-month evaluation and became more prominent after one year. No significant leg length discrepancy was found.

Implementation science for the adductor canal block: A new and adaptable methodology process.

BACKGROUNDFollowing the successful Perioperative Surgical Home (PSH) practice for total knee arthroplasty (TKA) at our institution, the need for continuous improvement was realized, including the deimplementation of antiquated PSH elements and introduction of new practices. AIMTo investigate the transition from femoral nerve blocks (FNB) to adductor canal nerve blocks (ACB) during TKA. METHODSOur 13-month study from June 2016 to 2017 was divided into four periods: a three-month baseline (103 patients), a one-month pilot (47 patients), a three-month implementation and hardwiring period (100 patients), and a six-month evaluation period (185 patients). In total, 435 subjects were reviewed. Data within 30 postoperative days were extracted from electronic medical records, such as physical therapy results and administration of oral morphine equivalents (OME). RESULTSOur institution reduced FNB application (64% to 3%) and increased ACB utilization (36% to 97%) at 10 mo. Patients in the ACB group were found to have increased ambulation on the day of surgery (4.1 vs 2.0 m) and lower incidence of falls (0 vs 1%) and buckling (5% vs 27%) compared with FNB patients (P < 0.05). While ACB patients (13.9) reported lower OME than FNB patients (15.9), the difference (P = 0.087) did not fall below our designated statistical threshold of P value < 0.05.CONCLUSIONBy demonstrating closure of the “knowledge to action gap” within 6 mo, our institution’s findings demonstrate evidence in the value of implementation science. Physician education, technical support, and performance monitoring were deemed key facilitators of our program’s success. Expanded patient populations and additional orthopedic procedures are recommended for future study.

Treating developmental dyslexia using transcranial stimulation combined with a reading stimulation program: A pilot study

Objective: Evaluate the effect of transcranial direct current stimulation (tDCS) combined with reading therapy on the performance of reading tasks in a serie of cases of children and adolescents with developmental dyslexia (DD). Method: (IRB/UNIFESP number:1281/2017). Four dyslexic students (two children and two adolescents) were evaluated with regards to rate and accuracy of reading fluency on three occasions: pre-intervention as well as one and six months after intervention. The intervention consisted of five consecutive sessions of active tDCS (1 mA for 20 minutes), followed by a two-day interval and another five sessions of tDCS combined with cognitive skills stimulation of phonological processing and decoding of words. Anodal tDCS was administered over the left parieto-occipital cortex, with the cathode placed over contralateral deltoid muscle. Each session was preceded by execution of semantic-lexical and phonological evocation tasks. Data were analyzed using Friedman test and JT method for analysis of clinical significance and the reliable change index. Results: Improvements were found in text reading rate and accuracy and word accuracy at the one-month and six-month evaluation. A significant increase was found in correct reading of words and pseudowords six months after intervention. Most of the improvements were reliable, with clinical significance in some cases. Conclusion: Transcranial direct current stimulation combined with a reading stimulation program proved effective at improving reading skills in these participants.

Impact of allogeneic feline uterine-derived mesenchymal stromal cell intravenous treatment on renal function of nephrectomized cats with chronic kidney disease

Chronic kidney disease (CKD) is a common condition and leading cause of mortality in cats. Mesenchymal stromal cells (MSCs) may have a therapeutic effect on CKD. The aim of this pilot study was to determine efficacy of systemically-administered allogeneic uterine tissue-derived MSCs (UMSCs) in cats with CKD. Eighteen renal-compromised, unilaterally nephrectomized cats received two doses of 3 × 107 allogeneic UMSCs given intravenously (IV) with a 2-week dose interval. The primary endpoint was renal function, with treatment success defined by a 20% increase in glomerular filtration rate (GFR; iohexol clearance) and/or a 20% decrease in plasma creatinine in 50% of the cats. Secondary endpoints included diet and water consumption, body weight, urine characteristics, and adverse events. Treatment was well tolerated and associated with a statistically meaningful increase in GFR on Days 13, 28, 57, 99, 121 and 182, compared with baseline (P < 0.0001 for Days 13 to 99 inclusive; P = 0.0029 and P = 0.0225 for Days 121 and 182, respectively). Greater than 50% of the cats demonstrated a 20% increase in GFR on all days except Day 150, at which point GFR measurements were consistently above baseline. Statistically meaningful increases in diet and water consumption were observed. Substantial improvements in GFR were observed throughout the six-month evaluation period (excluding Day 150) in more than 50% of cats, thereby meeting the primary endpoint. Therefore, this IV-administered, allogeneic cellular therapy may support both renal function and clinical status of cats with CKD.

Capacity building in participatory approaches for hydro-climatic Disaster Risk Management in the Caribbean

The participatory approach to Disaster Risk Management (DRM) considers socio-economic factors and facilitates the incorporation of local and indigenous knowledge into management plans while offering an opportunity to all resource users to have an input. Caribbean WaterNet/Cap-Net UNDP, Global Water Partnership-Caribbean (GWP-C), and the Faculty of Food and Agriculture, The University of the West Indies (FFA, UWI) conducted a series of regional training of trainers’ workshops in Integrated Urban Flood Risk Management and Drought Risk Management to build regional capacity in this approach. The trainings took place over two years in six (6) Caribbean Small Island Developing States (SIDS). Over 150 persons from a range of sectors relevant to water resource management participated and contributed. The workshop gathered information on sectoral impacts, potential mitigation measures and challenges of hydro-climatic hazards. Capacity building and knowledge transfer was evaluated at two stages; at the end of the last day of training and 6 months after, as part of a monitoring and evaluation assessment. Both the initial and 6-month evaluations revealed significant knowledge transfer and subsequent institutional and policy impacts. Initial evaluation indicated 99% participant satisfaction with both training content and structure. In the six-month evaluation, 85% of participants indicated that the knowledge gained was used to improve their work performance and, in some cases, contributed to changes in institutional policy and frameworks.

Evaluation of Immediate Implantation and Provisionalization Combined with Guided Bone Regeneration by a Flap Approach in the Maxillary Esthetic Zone: A Retrospective Controlled Study.

The aim of this research was too compare the thickness change of labial contour and bone tissues, as well as some biological complications of immediate implantation with and without immediate provisionalization for a single anterior maxilla presenting a vertical defect on labial bone with the need of guided bone regeneration (GBR) by a flap approach. A total of 40 single implants were placed in 40 patients into fresh extraction sockets of the anterior maxilla with a vertical defect on the labial bone (<4 mm). Simultaneously, GBR was conducted at the sites by a flap approach, and the implants were given immediate or delayed provisionalization. The thickness change of bone tissues during six-month evaluation and labial contour during three and six-month follow-up were measured. Complications such as implant and restoration survival rates, infection as well as wound exposure were also evaluated at six months postoperatively. After six months, the mean thickness losses in labial bone were 0.9040, 0.8050, 0.7165, 0.5285 and 0.5335 mm at five different sites in immediate provisionalization group, and 0.8780, 0.8605, 0.7560, 0.5900 and 0.6300 mm, respectively, in delayed provisionalization group, showing no significant difference between the groups at all measurement sites. Although the labial contour changes of the two groups were similar at most sites, the values at 1 and 2 mm above the implant neck remained significantly lower in the immediate provisionalization group at three and six months postoperatively. No complications occurred during the follow-up time. Based on the limitation of this study, the immediate implantation combined with GBR, flap operation and immediate provisionalization obtained acceptable outcomes for a single anterior maxilla with vertical defect on the labial bone, but more long-term research with a larger sample are urgently needed in the future.

Improvements in Hope, Engagement and Functioning Following a Recovery-Focused Sub-Acute Inpatient Intervention: a Six-Month Evaluation.

Few studies have examined the post-discharge benefits associated with recover-oriented programs delivered in inpatient and sub-acute mental health settings. The aim of this study was to evaluate the medium-term outcomes of a 6-week sub-acute inpatient intervention program for 27 service users with a diagnosis of serious mental illness (mean age = 33.22years, 70.4% with a psychosis diagnosis). Recovery data were collected on admission, at discharge, and at 3- and 6-months post-discharge using self-report, collaborative and clinical measures. The three clinician-rated measures (assessing therapeutic engagement, functioning, and life skills) revealed linear improvements from admission to 6-month follow-up (with mean z-change ranging from 0.72 to 1.35), as did the self-reported social connection measure (Mental Health Recovery Star, MHRS; mean z-change: 1.05). There were also curvilinear improvements in self-determination and self-reported MHRS symptom management and functioning scores; however, only modest changes were detected in hope (Herth Hope Index) and MHRS self-belief scores. Change scores based on self-reported and clinician-rated measures tended to be uncorrelated. An exploration of client-level outcomes revealed three recovery trajectory subgroups: transient (21.7%), gradual (34.8%), or sustained (43.5%) improvement; with members of the latter group tending to have longer illness durations. The study's findings are encouraging, to the extent that they demonstrate recovery-focused sub-acute inpatient programs can promote clinical recovery and aspects of personal recovery. However, they also suggest that recovery perspectives differ between clients and clinicians, and that far more work is required to understand the psychological factors that generate and sustain the hope that recovery is possible.

The Effects of Exergaming in Dementia

The Effects of Exergaming in Dementia

Six-Month Evaluation of a Transcatheter Aortic Valve (Myval) in a Novel Ovine, Supra-Aortic Banding Model

Six-Month Evaluation of a Transcatheter Aortic Valve (Myval) in a Novel Ovine, Supra-Aortic Banding Model

'The Mould that Changed the World': Quantitative and qualitative evaluation of children's knowledge and motivation for behavioural change following participation in an antimicrobial resistance musical.

BackgroundA primary school musical (“The Mould that Changed the World”) was developed as a unique public engagement strategy to combat antimicrobial resistance (AMR) by engaging children in the story of the discovery of antibiotics, the risks of drug-resistant infections and the importance of prudent antibiotic use.MethodsThe musical intervention was implemented in two UK primary schools by music specialists through a series of workshops, associated learning resources and performances to relatives. Participating children (n = 182), aged 9 to 11 years, were given an online questionnaire in the classroom before rehearsals began and at two weeks post-performance with a six-month evaluation in one school. The impact of the musical was analysed using generalised linear models to control for confounding factors. For the qualitative evaluation, fifteen participating children were selected randomly from each school to take part in semi-structured focus groups (n = 5 per group) before rehearsals began and two weeks post-performance.FindingsKnowledge gain was demonstrated with children being more likely to answer questions on key messages of the musical correctly at two weeks post- performance (response rate 88%, n = 161) compared with the pre-rehearsal questionnaire (response rate 99%, n = 180) (bacteria can become resistant to antibiotics OR 4.63, C.I. 2.46–9.31 p<0.0001, antibiotic resistant infections can be life threatening OR 3.26 C.I. 1.75–6.32 p = 0.0001, prudent use of antibiotics will slow the rise of antibiotic resistant infections OR 2.16, C.I. 1.39–3.38, p = 0.0006). Long term knowledge gain was demonstrated by a consistent level of correct answers on key messages between two weeks (response rate 95%, n = 89) and 6 months post musical (response rate 71%, n = 67). Following the musical children participating in the focus groups (n = 30) articulated a greater understanding of AMR and the risks of antibiotic overuse. They discussed motivation to minimise personal antibiotic use and influence attitudes to antibiotics in their family and friends.InterpretationThis study demonstrates that musical theatre can improve both short and long-term knowledge. It demonstrates a hitherto infrequently reported change in attitude and motivation to change behaviour in children at an influential age for health beliefs. This unique public health tool has the potential for high impact particularly if rolled out within national education programmes for primary school aged children.

Livelihood intervention and mental well-being among women living with HIV in Delhi

ABSTRACT Poverty-alleviation programmes aimed to improved mental well-being among persons living with HIV (PLWH) in low and middle income countries have underscored the importance of understanding how and why such programmes work. We present findings from a six-month ethnographic process evaluation of Kiran, an economic livelihood programme locally designed to improve mental well-being among women affected by HIV in Delhi, India. In addition to benefits of improved economic standing, we found that supportive relationships cultivated among participants (n = 9) and with providers (n = 3) provided respite from worry about their illness and reframed what was relationally and practically possible in the context of living with HIV. In acquiring marketable craft skills with peers, participants challenged internalized scripts of being socially devalued and regained agency about their abilities to contribute to their community and support their children’s immediate and future needs. We found that the benefits of Kiran weighed less on the direct alleviation of mental distress and more on the instillation of hope for their children. Our findings exemplify the importance of re-visiting a priori theories that inform interventions for PLWH and highlight the methodological merits of ethnographic approaches that underscore how theory and intervention praxis are bidirectionally informed.

Six-month results of stenting of the femoropopliteal artery and predictive value of interleukin-6: Comparison with high-sensitivity C-reactive protein.

To determine the association of pre- and postinterventional serum levels of interleukin-6 and high-sensitivity C-reactive protein at the six-month evaluation of restenosis after stenting of the femoropopliteal artery. Sixty-eight consecutive patients with steno-occlusive femoropopliteal artery disease of Rutherford category III or IV who underwent stent implantation were included. Six-month patency was evaluated with color-coded duplex ultrasound. The association of in-stent restenosis with interleukin-6 and high-sensitivity C-reactive protein levels at baseline, and 24-h postintervention was assessed with a multivariate logistic regression analysis. In-stent restenosis was found in 15 patients (22.1%) within six months. Interleukin-6 and high-sensitivity C-reactive protein levels were significantly increased at 24-h postintervention compared to their preintervention values (p < 0.001 and p = 0.002, respectively). Interleukin-6 values at baseline (odds ratio, 1.11; 95% confidence interval: 1.00, 1.23; p = 0.044) and 24-h postintervention (odds ratio, 1.04; 95% confidence interval: 1.02, 1.06; p < 0.001) were independently associated with six-month in-stent restenosis. Twenty-four-hour postinterventional high-sensitivity C-reactive protein levels were also found to be related to restenosis (odds ratio, 1.15; 95% confidence interval: 1.04, 1.26; p = 0.006), but high-sensitivity C-reactive protein levels at baseline did not show an independent association with in-stent restenosis (odds ratio, 0.57; 95% confidence interval: 0.35, 1.80; p = 0.667). Smoking, diabetes mellitus, and cumulative stent length were other parameters associated with an increased risk for in-stent restenosis. Femoropopliteal artery angioplasty with stent placement induces an inflammatory response. Interleukin-6 is a powerful independent predictor of intermediate-term outcomes for stenting of the femoropopliteal artery, suggesting that its predictive value may be superior to that of high-sensitivity C-reactive protein.

Thoracic ultrasound to differentially diagnose the cause of an opaque hemithorax (whiteout) when patients are referred for respiratory physiotherapy: A service evaluation

Purpose An opaque hemithorax commonly termed a ‘whiteout’ on chest radiograph (CXR) often results in a referral for urgent respiratory physiotherapy. This referral assumes that sputum plugging of either main bronchus has resulted in a whole lung collapse. There are, however, many alternative causes of an opaque hemithorax that would not respond to physiotherapy treatment. Referring medical professionals often use the position of the mediastinum, or more specifically the trachea on CXR to identify the cause of an opaque hemithorax but this may not be a reliable method. Thoracic ultrasound (TUS) could be used to better differentiate between the pathologies causing an opaque hemithorax prior to any physiotherapeutic interventions. We predict that TUS is more accurate than CXR alone in assisting respiratory physiotherapists to differentiate between the pathological causes of an opaque hemithorax. Method This service evaluation was undertaken within the acute hospital setting and included all patients referred for chest physiotherapy that had presented with an opaque hemithorax on CXR within the six-month evaluation period. A member of the investigating team performed a TUS scan within an hour of the referral. A respiratory physiotherapy treatment was performed where clinically indicated or if not indicated the patient was referred back to the referring clinician. Data collected included: the side of the opaque hemithorax and direction of any tracheal shift; documented reason for referral to physiotherapy; TUS scan findings; final medical team findings and the patient’s treatment or management plan. Results A total of nine patients were included in this service evaluation within the 6-month evaluation period. Five of the referrals (56%) presented with ipsilateral shifts. The remaining CXRs showed the tracheas to be in a central position. None of the patients referred showed a contralateral shift. The main documented reason for a referral for respiratory physiotherapy in these nine cases was ‘sputum plugging’, ‘consolidation’ or ‘lung collapse’. The primary findings on TUS were pleural effusion (44%), atelectasis (22%), consolidation (22%) and empyema (11%). In four cases the TUS findings highlighted that respiratory physiotherapy treatments remained indicated. In five cases the TUS scans highlighted findings that were not immediately amenable to respiratory physiotherapy. At the time of writing eight of the patients had not survived to the end of the six-month evaluation period. Discussion No referral was received by physiotherapy to review a patient with a contralateral shift. This suggests that the referring clinicians are using the position of the trachea on CXR as a way to justify the need for a respiratory physiotherapy referral. The use of the position of the trachea on CXR to accurately determine pathology and clinically justify the need for a physiotherapy referral appears to be unreliable. In our evaluation, sputum plugging and pleural effusions have both caused ipsilateral and central tracheal positions. The use of physiotherapy-initiated TUS has allowed five patients to avoid receiving inappropriate treatments. Alternate medical techniques such as pleural drain insertion, advanced imaging and palliation were employed to manage the patient’s clinical condition. One aspect of this service evaluation that was not predicted prior to its commencement was the mortality rate in these nine patients. Eight of them did not survive to the end of the six-month data collection period. Physiotherapists can use TUS to more accurately identify the causes of an opaque hemithorax prior to the initiation of physiotherapy treatments or limit delays in alternative treatment when physiotherapy is not indicated.